Varicose veins—those twisted, bulging “spider-like” or “rope-like” vessels visible beneath the skin of the legs—are far more than a cosmetic concern. Epidemiological data indicate that the prevalence of chronic venous disease in China reaches 10–20% among adults overall, and exceeds 30% in middle-aged and older populations. Left untreated, varicose veins can progress to serious complications including hyperpigmentation, lipodermatosclerosis, venous ulcers, superficial thrombophlebitis, and even deep vein thrombosis[1].
The underlying pathophysiology centers on valvular incompetence and venous reflux. As outlined in the Merck Manual, primary varicose veins most commonly arise from inherent weakness in the wall of the superficial veins—those located just beneath the dermis. This structural deficiency may be hereditary and tends to worsen over time: diminished venous elasticity leads to progressive elongation and dilation of the vessel. Constrained by surrounding tissue, the elongated vein becomes tortuous and visibly engorged—a hallmark clinical sign of chronic venous insufficiency[2].
Management follows a CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification–guided, stepwise approach. All patients diagnosed with varicose veins warrant intervention—not merely observation. First-line therapy is conservative: medical-grade compression stockings (typically Class II, 30–40 mmHg), avoidance of prolonged standing or sitting, regular calf muscle activation (e.g., walking, ankle pumps), and leg elevation. These measures reduce venous hypertension and slow disease progression[3]. For patients reporting persistent heaviness, aching, or edema despite conservative measures, pharmacologic support may be considered under physician supervision. Evidence-supported venoactive agents include micronized purified flavonoid fraction (MPFF), diosmin/hesperidin combinations, and aescin-based preparations such as horse chestnut extract (Aesculus hippocastanum).
Notably, daphnetin (a coumarin derivative marketed in China as Rui Xiang Su capsules) has demonstrated multimodal vascular effects relevant to complex lower-limb circulatory disorders. Preclinical and clinical studies report that daphnetin promotes coronary and peripheral vasodilation, enhances microcirculatory perfusion, inhibits platelet aggregation, suppresses arterial thrombus formation, and exerts anti-inflammatory activity via modulation of the hypothalamic-pituitary-adrenal axis[4]. Its therapeutic profile aligns with the pathophysiology of occlusive vascular diseases—including thromboangiitis obliterans (Buerger disease), lower-limb arterial stenosis, and diabetic peripheral artery disease.
This mechanistic rationale is reflected in clinical guidelines: The Integrated Traditional Chinese and Western Medicine Clinical Practice Guidelines for Diabetic Foot Associated with Peripheral Vascular Disease explicitly recommends daphnetin as an adjunctive agent for improving microvascular perfusion and mitigating inflammation in patients with diabetes-related lower-limb ischemia[5]. While not indicated as monotherapy for isolated varicose veins, daphnetin may offer targeted benefit in patients with coexisting venous insufficiency and concomitant microvascular dysfunction—particularly those with metabolic comorbidities such as type 2 diabetes.
A common misconception—that visible varicosities are benign and require no intervention—poses significant clinical risk. Progressive venous hypertension drives irreversible tissue remodeling, culminating in ulceration and impaired wound healing. Early diagnosis and timely, individualized treatment are essential not only to preserve limb function and quality of life but also to safeguard systemic vascular health. Clinicians should emphasize that varicose veins represent a chronic, progressive disorder demanding proactive management—not passive acceptance.